Ahmet Dobrucali

Role of host interleukin 1β gene (IL-1B) and interleukin 1 receptor antagonist gene (IL-1RN) polymorphisms in clinical outcomes in Helicobacter pylori-positive Turkish patients with dyspepsia

BackgroundHelicobacter pylori infection leads to different clinical outcomes depending on both host and bacterial factors. In a recent study, we identified H. pylori cagE and babA2 genotypes as independent predictors of duodenal ulcer (DU) and gastric cancer (GC) in dyspepsia patients, but no previous studies have examined the role of host-related genetic factors in Turkey. This time our aim was to evaluate whether polymorphisms of the interleukin 1B (IL-1B) and the interleukin 1 receptor antagonist (IL-1RN) genes are important factors in the differential expression of gastroduodenal diseases in H. pylori-positive dyspepsia patients.MethodsNinety-three H. pylori-positive patients, 30 with nonulcer dyspepsia (NUD), 30 with DU, and 33 with GC, were investigated. The IL-1B-511 and IL-1B-31 biallelic polymorphisms, and the IL-1RN intron 2 variable number tandem repeat were genotyped by polymerase chain reaction and single-strand confirmation polymorphism analysis.ResultsThe IL-1RN-1/1 genotype was significantly more prevalent among patients with NUD than among those with GC (χ2 = 9.270; P = 0.002), and the IL-1RN-1/2 genotype was significantly more common in patients with GC (χ2 = 6.01; P = 0.014). Multivariate regression analysis showed that cagE, babA2, and IL-1RN-1/2 genotypes were independent predictors of GC, but when patients with benign disorders were grouped together (NUD + DU) and compared with patients with GC, regression analysis disclosed that babA2 (P = 0.000) and IL-1B-31 gene polymorphisms (CC or CT) (P = 0.01) were the only independent markers of GC.ConclusionsWhen analyzed together with host genetic factors, the wellestablished bacterial risk factor babA2 seems to be the most important predictor of malignant disorders, and the presence of the IL-1B-31TT genotype emerges as a protective factor against them.

Critical pH level of lye (NaOH) for esophageal injury.

Aim/Background Lye (NaOH) ingestion in humans often results in alkaline damage to the esophagus, but knowledge about this process is limited. Here, we explore the effects of lye on esophageal epithelial structure and function using rabbit esophageal epithelium as a model of lye ingestion. Methods Rabbit esophageal epithelium was mounted in Ussing chambers so that the electrical potential difference (PD), short-circuit current (Isc), and transepithelial resistance (RT) could be monitored before, during, and after mucosal exposure to lye (NaOH) at pHs ranging from 7.4 to 12.1. Histopathology and dextran fluxes were also performed and correlated with the electrical data. Results Mucosal exposure to lye at pHs <11.5 had no damaging effects on the esophagus. However, at pHs ≥11.5, damage was both time- and pH-dependent, as noted by increases in PD and Isc, and declines in RT. Further, the electrical changes were paralleled morphologically by epithelial liquefaction necrosis and increases in dextran flux. Also, by pretreating tissues with ouabain, the early lye-induced rise in PD and Isc was shown to result from a combination of increased active (sodium) transport and passive (sodium) diffusion which indicates that, even early on, the damaging effects of lye include changes in both apical cell membranes and tight junctions of this epithelium. Conclusion Lye (NaOH) injury to the esophageal epithelium is both pH- and time-dependent, but requires a minimum pH of 11.5. At pHs ≥11.5, lye produces liquefaction necrosis, an injury that involves both cellular and junctional barriers, and which markedly increases epithelial permeability to ions and uncharged molecules. Based on these results, non-industrial cleaning products in the home are likely to be safer if they have a concentration of lye below pH 11.5.

Gastric balloon to treat obesity: Filled with air or fluid?

Our aim was to study the efficacy and safety of different types of intragastric balloon in morbidly obese patients.

Autoantibody Frequency in Celiac Disease

AIM: In our study, we investigated the levels of glutamic acid decarboxylase antibody (anti-GAD), islet cell antibody (ICA), thyroperoxidase antibody (anti-TPO), thyroglobulin antibody (anti-TG), antinuclear antibodies (FANA), antibodies to double-stranded DNA (anti-ds DNA), antibody to Sjögren syndrome A antigen (anti-SSA), antibody to Sjögren syndrome B antigen (anti-SSB), Smith antibody (anti-Sm), smooth muscle antibodies (ASMA), and antimitochondrial antibody liver-kidney microsome (AMA-LKM) in patients with celiac disease as compared to healthy controls and autoimmune hypothyroid patients. MATERIALS AND METHODS: A total of 31 patients with celiac disease, 34 patients with autoimmune hypothyroidism and 29 healthy subjects were included in this study. Anti-SSA, anti-SSB, anti-Sm, anti-ds DNA, anti-GAD, anti-TPO and anti-TG were studied by Enzyme-Linked Immunosorbent Assay (ELISA), and AMA-LKM, ASMA, ANA and ICA were studied by immunofluorescence. Clinical data and the results of free thyroxine-thyroid stimulating hormone (FT4-TSH) were collected from the patients’ files by retrospective analysis. SPSS ver 13.0 was used for data analysis, and the χ2 method was used for comparisons within groups. RESULTS: The frequency of anti-SSA, anti-SSB, anti-GAD, anti-Sm, anti-ds DNA, AMA-LKM, ASMA, ANA and ICA were not significantly different between the groups. Levels of anti-TPO and anti-TG antibodies were found to be significantly higher (<0.001) in autoimmune hypothyroid patients when compared with other groups. CONCLUSION: In previous studies, an increased frequency of autoimmune diseases of other systems has been reported in patients with celiac disease. We found that the frequency of autoimmune antibodies specific for other autoimmune diseases was not higher in celiac disease.

CASE REPORT: Cytomegalovirus Infection of Gastrointestinal Tract with Multiple Ulcers and Strictures, Causing Obstruction in a Patient with Common Variable Immunodeficiency Syndrome

Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by panhypogammaglobulinemia (especially decreased production of IgG but frequently also IgA and IgM, recurrent bacterial infections, and different gastrointestinal appearances), especially inflammatory bowel disease and granulomatous enteropathy, and increased incidence of malignant and autoimmune disease. A small subpopulation of these patients has reduced numbers of circulating B lymphocytes, suggesting a central failure of the development of this cell line (1–3). In 80–90% of the patients there are normal numbers of B lymphocytes, with immature phenotype, because these cells fail to differentiate into immunoglobulin-secreting plasma cells (4). Most patients with this disorder appear to have an intrinsic B-cell defect. Consistent with the evidence that B lymphocytes are able to recognize the antigens and proliferate but fail to differentiate to plasma cells is the fairly common finding of lymphoid hyperplasia, including splenomegaly and nodular hyperplasia of the gut. In some patients, an increase in T-suppressor activity, quantitative deficiency of helper T cells, and production of abnormal immunoglobulins, which are degraded in cytoplasm, have been observed. Two thirds of patients with common variable immunodeficiency have a normal CD4/CD8 ratio, one third has increased relative and absolute numbers of CD3 and CD8 peripheral blood lymphocytes, resulting in a decreased CD4/CD8 ratio. Less than 10% of the patients with normal ratios and 40% with a decreased ratio are anergic, and 30% of the patients with normal ratios and 70% with decreased ratios have splenomegaly (5). Most of the CD8 T cells expressed the CD57 antigen and activation antigens (HLA-DR) (6). Cytomegalovirus (CMV) is a member of the herpesvirus group and causes a wide spectrum of disorders, ranging from an asymptomatic, subclinical infection to a mononucleosis syndrome in healthy individuals to disseminated disease in the immunocompromised host (7). CMV contains doublestranded DNA, a protein capsid, and a lipoprotein envelope and replicates in the cell nucleus. Virus replication is associated with the production of large intranuclear inclusions and smaller cytoplasmic inclusions. Once infected, an individual probably carries the virus for life. Most commonly these infections remain latent. However, with compromise of Tlymphocyte-mediated immunity, CMV reactivation syndromes frequently develop (8). These cells in vivo Manuscript received April 10, 1999; accepted January 31, 2000. From the Internal Medicine Department, Gastroenterology Department, General Surgery Department, Department of Pathology, and Infectious Diseases Department, Cerrahpasa Medical Faculty, University of Istanbul; and Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Pittsburgh, Pennsylvania. Address for reprint requests: Dr. Veysel Tahan, Cerrahpasa Medical Faculty, Internal Medicine Department, 34303 Aksaray, Istanbul, Turkey. Digestive Diseases and Sciences, Vol. 45, No. 9 (September 2000), pp. 1781–1785

Role of oxidative stress and insulin resistance in disease severity of non-alcoholic fatty liver disease.

BACKGROUND/AIMS Oxidative stress and insulin resistance (IR) are major contributors in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). The purpose of this study was to find the relation between oxidative stress parameters and histopathological findings in NAFLD patients with and without insulin resistance (IR). MATERIALS AND METHODS Thirty-two patients with no alcohol intake and biopsy-proven diagnosis of NAFLD were studied (M/F: 17/15; mean age 46.5±11.4 years). Twenty-one NAFLD patients with IR were compared with 11 patients without IR. The fasting insulin level was measured, and the insulin resistance index was calculated using the homeostasis model assessment (HOMA) method. Malondialdehyde (MDA) and superoxide dismutase (SOD) activities were measured in tissue and serum specimens. Glutathione (GH) was measured in tissue homogenates. Nitric oxide (NO), vitamin E and C levels were measured in serum. RESULTS Patients with IR had significantly higher tissue MDA levels (p=0.001) and significantly decreased tissue SOD and GH levels (p=0.001 and 0.002, respectively) than those without IR. The steatosis grade, necroinflammatory grade and stage were significantly higher in patients with IR (p=0.035, 0.003 and 0.001, respectively). HOMA IR significantly correlated with the necroinflammatory grade, stage, tissue MDA, SOD and GH (p=0.013, 0.001, 0.008, 0.001 and 0.001, respectively). Serum MDA (β=1.88, p=0.002), serum SOD (β=0.57, p=0.006), tissue MDA (β=0.22, p=0.006), tissue SOD (β=1.48, p=0.071) and stage (β=2.81, p=0.003) were independently associated with increased HOMA IR. Increased MDA [OR: 1.51; 95% CI: (1.03-2.22); p=0.034] was a risk factor for non-alcoholic steatohepatitis (NASH), and increased SOD activity had a preventive effect against NASH [OR: 0.008; 95% CI: (0.001-0.98); p=0.04]. CONCLUSION This study shows that insulin resistance in NAFLD correlates with enhanced oxidative stress. Histopathological disease severity significantly correlated with oxidative stress parameters. These data show that NAFLD patients with IR may have increased risk for disease progression.

Self-Expandable Metallic Stent Placement in the Palliative Treatment of Malignant Obstruction of Gastric Outlet and Duodenum

Background/Aims To asses the usefulness of flexible metallic stents in the palliation of malignant obstruction of gastric outlet and duodenum. Methods Retrospective review was performed between January 2006 and December 2011 in 30 patients. Thirty consecutive patients with obstruction of the gastric outlet underwent palliative treatment with self-expandable flexible metallic stents. Complications and clinical outcomes were assessed. Results Twenty-four patients had advanced gastric carcinoma at the antrum and/or pylorus, four patients had obstruction at the pylorus due to pancreas tumours and one patient had duodedum and one patient had gall bladder tumour. Symptoms improved in 82.7% of the patients after the procedure. The improvement in ability to eat using the score system was statistically significant (p<0.001). Tumor ingrowth and/or overgrowth were seen in four patients (13.3%), and a second stent was inserted in these patients. The mean stent patency was 100 days (range, 5 to 410). The mean survival was 120.76±38.96 days. Conclusions Endoscopic placement of self-expendable metallic stents under fluoroscopy is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach or pancreas cancer.

Is Intraluminal Clip Application an Appropriate Treatment for Iatrogenic Gastric Perforation

Background: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. Method: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. Results: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). Conclusions: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.

The Changing Pattern of Upper Gastrointestinal Disorders by Endoscopy: Data of the Last 40 Years

Objectives. We have investigated the changes in the incidence of various diagnoses that have been made in the endoscopy unit throughout the last 40 years. Methods. In this study, changes in the incidence of endoscopic diagnosis in upper gastrointestinal system between 1970 and 2010 were evaluated. Their diagnosis, age, and gender data were entered into the Excel software. Results. Of the 52816 cases who underwent esophagogastroduodenoscopy in the 40-year time period, the mean age was 48.17 ± 16.27 (mean ± SD). Although overall more than half of the patients were male (54.3%), in 1995 and after a marked increase was seen in the proportion of female gender (51–55%). The presence of hiatal hernia, reflux esophagitis, and the number of Barretts esophaguses significantly increased. Erosive gastritis showed gradual increase, while the number of gastric ulcers decreased significantly. The presence of gastric and esophageal cancer significantly decreased. The number of duodenal ulcers significantly decreased. Conclusion. We detected that the incidences of esophagitis, Barretts esophagus, and erosive gastritis significantly increased while the incidences of gastric/duodenal ulcer and gastric/esophageal cancer decreased throughout the last 40 years.

Prevalence of fecal incontinence and associated risk factors in elderly outpatients: a cross-sectional study

BackgroundData on the prevalence of fecal incontinence in elderly patients admitted to outpatient clinics in Turkey are scarce.AimsThe aim of this study was to assess the prevalence of fecal incontinence and the associated risk factors in the elderly outpatients.MethodsPatients 60 years and older admitted to a geriatrics outpatient clinic between October 2013 and March 2014 were included. Demographic characteristics, anthropometric measurements, marital status, educational status, parity (for females), fecal incontinence (FI), urinary incontinence (UI), constipation, comorbid conditions, and medications were recorded. FI assessment was based on the Fecal Incontinence Severity Index (FISI).ResultsA total of 364 patients (64.8% female, n = 236) with a mean age of 73.2 ± 8.1 years were enrolled in the study. The prevalence of FI was 9.9% (10.2% female, 9.4% male). UI was 42.6%. Co-occurrence of FI and UI was 7.4%. According to the FISI, the most frequent type of defecation was liquid stool (61.1%). While the predictive factors for FI were polypharmacy (standardized coefficient, [r] = 0.203, 95% confidence interval [CI] = 0.009–0.040, p = 0.002), UI (r = 0.134, 95% CI = 0.006–0.156, p = 0.035), and being married (r = 0.200, 95% CI = −0.088 to −0.020, p = 0.002) in females, those were UI (r = 0.306, 95% CI = 0.093–0.309, p < 0.001) and polypharmacy (r = 0.251, 95% CI = 0.009–0.043, p = 0.003) in males.ConclusionsIn both genders, urinary incontinence and polypharmacy seem to be the most important risk factors for fecal incontinence. Fecal incontinence should be questioned in detail and evaluated using FISI in elderly outpatients.